MASLD Recognition Lags Fatty Liver Disease in US Survey

Key Takeaways

• Among surveyed US adults with body mass index ≥27, prediabetes, or type 2 diabetes, MASLD and MASH were less familiar than fatty liver disease.
• Liver disease elicited less concern than obesity, hypertension, and diabetes.
• Familiarity with liver terminology was greater among respondents reporting a previous MASLD diagnosis.

For people with elevated body mass index (BMI), prediabetes, or type 2 diabetes, liver health competes with other metabolic concerns. Different names for steatotic liver disease raise a question about which terms patients recognize when discussing their health. Clinicians may encounter that uncertainty when discussing liver health with patients at metabolic risk, prompting White and colleagues to survey these adults.

In a research letter on metabolic liver disease awareness, the investigators reported a cross-sectional YouGov online-panel survey of US adults fielded in February. They recruited 3,010 adults, retained 2,581 in a demographically matched dataset, and analyzed 1,000 eligible respondents with BMI ≥27, prediabetes, or type 2 diabetes. Matching used gender, age, race, and education against a frame derived from the American Community Survey. A brief questionnaire assessed familiarity with liver terms, including metabolic dysfunction–associated steatotic liver disease (MASLD) and metabolic dysfunction–associated steatohepatitis (MASH). It also asked about concern regarding obesity, hypertension, diabetes, and liver disease; prior self-reported MASLD diagnosis; current health care contact; and whether a doctor had mentioned metabolic-management strategies. Investigators reported descriptive comparisons, not findings from disease screening or an intervention.

Recognition differed by terminology: 60% of analyzed respondents reported familiarity with fatty liver disease, compared with 13% for MASLD and 12% for MASH. Cirrhosis was comparably familiar to fatty liver disease, while nonalcoholic fatty liver disease and liver fibrosis had intermediate recognition. Familiarity was slightly higher among respondents with diabetes or prediabetes than among respondents with elevated BMI; these groups were not presented as mutually exclusive. Familiarity was higher among those reporting a previous MASLD diagnosis or indirect exposure. These patterns describe recognition of terms, not whether respondents had liver disease.

Concern about liver disease was reported by 13% of respondents, compared with 57% for obesity and 48% each for hypertension and diabetes. Concern and familiarity were separate self-reported measures; neither the concern responses nor a reported previous MASLD diagnosis establishes an individual’s perceived likelihood of developing liver disease.

BMI, diabetes, and MASLD status were self-reported, and online-panel selection may have shaped responses despite demographic matching. Without a definitive sampling frame for adults at risk of MASLD, the selected eligible group should not be treated as nationally representative. Alcohol-associated liver disease categories were not addressed separately, limiting interpretation of alcohol-related contributions to awareness or concern. Cross-sectional responses establish neither why terms were unfamiliar nor whether familiarity affects diagnosis timing, screening, education, or treatment.

White and colleagues proposed that communication about metabolic pathways, early recognition, and potential reversibility might address the recognition gap. The survey did not test an educational or screening effect; it documented a mismatch between familiarity with fatty liver disease and recognition of the newer MASLD and MASH terms in this surveyed group.

Clinician Questions

Could the 2023 change in fatty liver disease terminology explain low MASLD recognition among US adults?

White and colleagues suggested that delayed uptake of the change from nonalcoholic fatty liver disease terminology could contribute to lower recognition of MASLD and MASH among surveyed US adults with metabolic risk. The cross-sectional survey did not establish that explanation as a cause.

How often did US survey respondents with diabetes or prediabetes express concern about diabetes?

Among surveyed US adults with diabetes or prediabetes who met the metabolic-risk eligibility criteria, 81% reported concern about diabetes. This was self-reported concern, not an objective measure of disease risk.

Among US respondents reporting MASLD, how did concern about obesity compare with concern about liver disease?

Among eligible surveyed US adults reporting a previous MASLD diagnosis, 69% expressed concern about obesity and 39% about liver disease. Diagnosis and concerns were self-reported; the comparison does not establish a statistically significant difference or measured personal risk.